慢性粒细胞白血病并发皮肤鳞癌1例报道

0 引言 皮肤癌是常见的恶性肿瘤之一,大多数是由于太阳辐射中的紫外线照射所致.某些因素也可能与皮肤癌的发生有关,如电离辐射,经常接触砷、柏油或沥青,各种癌前病变以及免疫抑制和种族等.羟基脲是一种核苷二磷酸还原酶抑制剂,广泛应用于慢性粒细胞白血病的治疗.现报道1例慢性粒细胞白血病患者使用羟基脲10年后并发皮肤鳞癌,使用CAP方案化疗后取得较好疗效,可为晚期皮肤鳞癌患者的全身化疗提供依据. 1 病例资料 患者,男,45岁.于1996年6月确诊为慢性粒细胞白血病(CML),1996年6月 2007年9月长期口服羟基脲治疗.患者自2007年9月开始出现右手背及右手掌处多发疣状物、伴溃疡形成,行原发灶切除+植皮术,术后病理示皮肤高分化鳞状细胞癌.术后停服羟基脲,2007年10月开始口服格列卫(400毫克/日)治疗,2011年9月复查染色体及融合基因无改变,开始改服尼洛替尼胶囊(800毫克/日)治疗,CML病情稳定.     

减低剂量甲磺酸伊马替尼治疗慢性粒细胞白血病慢性期患者一例并文献复习

目的 提高对减低剂量甲磺酸伊马替尼(STI571)治疗慢性粒细胞白血病慢性期(CML-CP)的认识.方法报道1例减低剂量STI571(200 mg/d)治疗CML-CP患者,并对应用低剂量STI571后血药浓度与疗效的关系等进行文献复习.结果低剂量STI571治疗CML-CP在少数不能耐受最佳剂量的患者中可能有效,其血药浓度可达到与标准剂量相同的血药浓度水平.结论CML-CP患者推荐采用标准剂量STI571治疗,但不能耐受标准剂量者在监测血药浓度条件下采用低剂量STI571可能有效.     

肺鳞癌皮肤转移1例并文献复习

1病例资料 患者,男,61岁,因“背部、左上臂、额头结节脓疱4月余”入我院皮肤科.4月前无明显诱因患者背部、左上臂、额头出现暗红色结节,质硬,活动度欠佳,边缘不清楚,结节顶端有脓疱,无破溃,无疼痛感,结节生长较缓,3周前至当地诊所就诊,予以“左上臂结节局部切除术”,上覆粉状药物(具体不详),切除后皮损加重,后至我院.     

酪氨酸激酶抑制剂致慢性髓系白血病患者乙肝再激活1例并文献复习

0引言酪氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)作为一类针对酪氨酸激酶的分子靶向治疗药物,已成为慢性髓系白血病(chronic myelogenous leukemia,CML)患者药物治疗的首选。近年来出现了合并慢性HBV感染的CML患者接受TKI治疗后发生乙肝再激活的报道,引起医疗工作者对该药物靶向外不良反应的关注。基于此,本文通过报道1例CML患者在服用第一代TKI伊马替尼的过     

尼洛替尼一线治疗慢性髓系白血病的进展

慢性髓系白血病(CML)是一类骨髓增殖性肿瘤,其发病机制与BCR/ABL融合基因相关。酪氨酸激酶抑制剂(TKI)可显著改善CML患者的生存及预后。尼洛替尼一线治疗CML患者疗效显著、治疗反应快、缓解程度深并且安全性高。在获得持续深层分子反应后,实现停止尼洛替尼用药并达到无治疗缓解是CML治疗的新目标。此外,由于疾病耐药及突变的产生,尼洛替尼治疗失败后如何开始新的治疗值得进一步研究。     

影响慢性粒细胞白血病疗效的因素

慢性粒细胞白血病（CML）简称慢粒,是一种发生在多能造血干细胞的恶性骨髓增殖性肿瘤。慢粒现有的治疗方法包括羟基脲、干扰素、酪氨酸激酶抑制剂（TKI）、造血干细胞移植等。这些治疗方法均存在一些因素影响了慢粒的疗效,通过阅读相关文献总结发现:慢粒疗效的减弱可能与以下几个方面如信号传导、血红素加氧酶-1的作用、自噬、药物代谢与生物活性、个体差异、一氧化氮以及移植物抗宿主病等相关。本文对这些因素进行阐述,通过对这些因素的深入研究可以进一步改善慢粒的疗效以提升慢粒患者的生存质量。     

Treatment of Cutaneous T-cell Lymphoma with Cyclosporin A: Case Report and Literature Review

A 48 year old Caucasian man with cutaneous T-cell lymphoma, stage IVB is described. Initially he presented with an ichthyosis-like dermatosis and developed lymphadenopathy, hypercalcaemia, hepatosplenomegaly and lymphomatoid papulosis over a period of 7 years. Following splenectomy he developed a leukemic phase which was refractory to polychemotherapy. Therapy with cyclosporin A initially caused deterioration of the skin infiltrations and the peripheral blood T-helper lymphocytosis. However after 3 weeks an improvement of the patient's general condition was noted including decreased skin involvement, reduction of hepatomegaly and a sustained decrease of the absolute lymphocytosis, which lasted for ten months. Lymphomatoid papulosis was not significantly affected by cyclosporin A. In conclusion, this case and several case reports from the literature suggest that cyclosporin A may be valuable in the palliative treatment of selected patients with advanced cutaneous T-cell lymphoma.     

Successful Completion of Pregnancy in a Patient With Chronic Myeloid Leukemia Without Active Intervention: A Case Report and Review of the Literature

The management of patients with chronic myeloid leukemia (CML) during pregnancy is a matter of continued debate. We present a 21-year-old woman in whom CML was diagnosed during early pregnancy. Because the patient was asymptomatic and desired to carry the pregnancy to term while minimizing fetal exposure to medication, she was observed with no therapy for the duration of her pregnancy. The white blood cell count showed a slow downward trend throughout her pregnancy. She delivered a healthy baby and breast fed for a time before initiating therapy for CML. We reviewed the published case reports of women who had a pregnancy occur in the setting of treatment with imatinib. Given the adverse effects of fetal exposure to imatinib as treatment for the mother with CML, close observation might be an option for selected patients who are diagnosed with CML while pregnant and who have minimal clinical manifestations of CML.     

Dasatinib and Chronic Myeloid Leukemia: Two-Year Follow-up in Eight Clinical Trials

Imatinib is currently regarded as the best initial treatment for patients with chronic myeloid leukemia (CML). However, a significant proportion of patients who relapse, fail to respond, or develop intolerance might benefit from the use of second-generation tyrosine kinase inhibitors. In this review, we report the 2-year results in 8 clinical trials involving more than 2000 patients treated with dasatinib (phases I-III). Patients with CML who had failed to respond or were intolerant to imatinib were enrolled in a phase I trial. The positive results emanating from this study led to a series of 5 phase II trials known as START (SRC/ABL tyrosine kinase inhibition activity: research trials of dasatinib). In addition, 2 phase III dose-optimization trials have now been completed. These trials demonstrate that dasatinib offers clinical benefit to patients resistant or intolerant to imatinib, with a well-described and manageable adverse event profile.     

肺移植治疗肺癌1例报告并文献复习

背景与目的肺癌被认为是肺移植的相对禁忌症,但随着移植技术的进步,此类非常规疾病也被纳入肺移植适应症.本文通过报道l例双肺移植成功治疗双侧肺癌男性患者的病例,并结合相关文献复习,探讨肺移植治疗肺癌的适应症及疗效.方法2010年l0月21日南京医科大学附属无锡市人民医院肺移植组为1例42岁男性患者成功进行了序贯式双肺移植,该患者术前胸部CT及PET-CT示双肺多发斑片状及团块样浸润阴影,纵隔淋巴结不肿大,其余部位未见转移.术后病理证实为粘液型细支气管肺泡癌,分期T4N0M0,Ⅲb期.结果患者术后予常规三联免疫抑制,抗细菌、真菌、病毒等一系列治疗,并于术后66天恢复良好出院并定期随访,术后6个月随访时肺功能良好,未见明显转移征象.结论对于某些合适的肺癌患者,肺移植是一个有效的治疗方法.     

达沙替尼二线治疗儿童慢性髓性白血病临床分析

摘 要：［目的］探讨达沙替尼（dasatinib,DAS）二线治疗儿童慢性髓性白血病（chronic myeloid leukemia,CML）的疗效、安全性及不良反应。［方法］ 回顾性分析一线伊马替尼（imatinib,IM）治疗未获得满意疗效或因不耐受更换为国产DAS（依尼舒）二线治疗的CML慢性期（CML-CP）9例儿童患者的临床资料,分析其临床特征、治疗效果及不良反应。［结果］ 9例患者确诊患病时中位年龄10（3~14）岁,更换DAS时中位年龄14岁（5~16）岁,换药后中位随访时间28（12~38）个月。3个月、6个月、12个月获得主要分子学反应（MMR）的比例分别为44.4%、44.4%和55.6%。22.2%患者出现1级白细胞减少;22.2%患者出现贫血,1例为轻度,1例为中度;33.3%患者出现血小板减少,其中1~2级2例,3级1例。11.1%患者出现头痛、头晕,11.1%患者出现肌肉骨骼酸痛;11.1%患者出现轻度腹泻;33.3%患者出现皮疹;无肺动脉高压、胸腔积液、心包积液、肺水肿发生,定期肝肾功能检测未见明显异常。［结论］ DAS治疗儿童CML安全、有效,IM耐药或不耐受的儿童可考虑更换为DAS治疗。     

胆囊癌并慢性粒细胞性白血病、脾亢1例

患者男性 ,５４岁 ,因右上腹痛２年加重１个月 ,于２０００年５月１５日入院。查体 :右上腹压痛 ,肝脾未及。Ｂ超 :胆囊体部后壁见一３．２ｃｍ×１．８ｃｍ实性强回声团块 ,脾脏增大 ,厚约５．６ｃｍ。血常规 :ＷＢＣ４．７×１０９／Ｌ,ＲＢＣ３．９７×１０１２／Ｌ,ＰＬＴ３２×１０９／Ｌ,乙肝五项阴性 ,肝功能正常 ,诊断 :胆囊肿瘤、脾亢。术前输入血小板１Ｕ ,于５月２３日全麻下行胆囊、脾切除术。病理检查 :胆囊大小８ｃｍ×５ｃｍ×０．３ｃｍ（剪开后量） ,体部见一簇菜花样肿物 ,大小２ｃｍ×１．３ｃｍ×１ｃｍ ,切面灰白色 ,…